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Heme boards > Transfusion medicine > Flashcards

Transfusion medicine Flashcards

1
Q

Calcium derangement associated with massive transfusion + mechanism

A
  • hypocalcemia
  • Blood is anticoagulated with sodium citrate and citric acid [49]. Each 450 mL unit of blood (or 500 mL unit in Europe) contains 9 mmol of citrate. As a result, massive transfusion leads to infusion of a large amount of citrate.
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2
Q

Management of hypocalcemia following massive transfusion

A
  • administer calcum only to treat symptomatic hypocalcemia
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3
Q

Presentation of hypocalcemia following massive transfusion

A

early → hyperactive DTR’s
severe → seizures, twitching, cardiac arrythmia (prolonged QT)

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4
Q

Indications for irradiated blood products

A

*immunocompromised
- transplant patients
- congenital t cell immunodeficiency
- heme malignancies
-intrauterine or neonatal transfusion
4) *fludarabine or cladribine

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5
Q

Why irradiate blood products?

A

Prevent transfusion associated GVHD

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6
Q

when is leukoreduction indicated?

A

1) CMV transmission risk
*History of febrile NHTR
*At risk for HLA alloimmunization (sickle cell pts, chronically transfused patients)

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7
Q

Indications for washing cell products?

A

1) history of anaphylaxis
2) IgA deficient
*neonatal or intrauterine transfusion

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8
Q

What is the risk associated with washing blood products?

A

hyperkalemia

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9
Q

Cause of acute hemolytic reactions?

A

ABO mismatch

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10
Q

Etiology of delayed hemolytic reactions?

A

transfusion recipient has antibodies that react with antigens on incompatible donor red blood cells (so ABO but also can be duffy, kell, kid, etc)

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11
Q

Time window for delayed hemolytic transfusion reaction?

A

5-14 days post transfusion

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12
Q

Febrile non hemolytic transfusion reaction mechanism

A
  • cytokines and leukocytes in blood products
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13
Q

Febrile non hemolytic transfusion reaction 1) acute management 2) management of future transfusions

A
  • supportive care w/ antipyretics
  • leukoreduction for future transfusions
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14
Q

Etiology of urticarial reactions

A

Antibodies to donor plasma

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15
Q

1) Management of urticarial reactions 2) Can you continue transfusion?

A

1) benadryl
2) Yes, slowly

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16
Q

TRALI mechanism

A

Antibodies directed toward human leukocyte antigens (HLA) or human neutrophil antigens (HNA) have been implicated, with transfused antibodies shown to bind antigens expressed on pulmonary endothelial cells to initiate acute inflammation in the lungs

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17
Q

TRALI radiographic findings

A
  • bilateral infiltrates (see photo online)
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18
Q

TRALI clinical features

A

acute hypoxemic respiratory failure + within 6 hours of transfusion + CXR is diffuse opacity

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19
Q

1) Management of anaphylaxis with transfusions 2) subsequent management

A
  • supportive care w/ steroids + epi
  • check IgA (CONFIRM)
    2) washed products
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20
Q

Post transfusion purpura 1) timeframe 2) mechanism 3) management 4) clinical scenario 5) management of subsequent platelet transfusions

A

1) 5-14 days
2) antibodies to platelet antigens - patient develops antibodies to the HPA-1a antigen leading to platelet destruction
3) PLEX, IVIG
4) pregnant patient
5) ***transfuse HPA-1a antigen negative platelets

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21
Q

Infectious risks of transfusion

A

HIV - 1 in 1.5 million
Hepatitis - 1 in 1 million
Bacteria - 1 in 75k

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22
Q

In what blood product is bacterial transmission more common?

A
  • platelets (stored at room temp)
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23
Q

What infections are screened for in the US

A
  • HIV
  • hep b and c
  • HTLV
  • west nile
  • syphilis
  • chagas
  • babesia
  • malaria if recent travel
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24
Q

Highest risk pathogen in transfusion

A

hep b

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25
Q

TACO vs. TRALI

A

TACO - evidence of volume overload (JVD, BNP elevation) + underlying CHF or CKD

26
Q

Platelet transfusion goal for central line placement

A

20k

27
Q

Contraindications to platelet transfusion

A

HIT (increases risk of arterial thrombosis + mortality)
TTP
ITP (relative)

28
Q

What does cryo contain

A

Factor VIII
VWF
Factor XIII
Fibrinogen
Fibronectin

29
Q

Management of uremic platelet dysfunction

A
  • Given that patient has acute bleed AND no hyponatremia, recommend DDAVP 0.3 mcg/kg
  • Hemodialysis will partially correct bleeding time and improve uremic platelet dysfunction
  • Platelet transfusion generally not advised in patients with uremic platelet dysfunction as transfused platelets would acquire the same defects
  • Given severe bleeding, recommend cryoprecipitate infusion (10 units q24h until resolution of bleed)
30
Q

Complications of massive transfusion

A
  • coagulopathy from loss of clotting factors
  • hypocalcemia
  • hypothermia
  • QT prolongation
31
Q

Target Hbs in red cell exchange for acute chest syndrome

A

Less than 30%

32
Q

Risks of apheresis

A

*electrolyte derangements due to citrate used as anticoagulant
- hypokalemia
- hypocalcemia
- hypomagnesemia
- hypotension (fluid shifts)
- immunoglobulin deficiency

33
Q

Drug to avoid with PLEX

A

ACE inhibitors (infusion of bradykinin)

33
Q

Indications for PLEX

A
  • CIDP (chronic inflammatory demyelinating polyneuropathy)
  • Cryoglobulinemia
  • CTCL
  • TTP
  • Good pasture syndrome
  • Familial hypercholesterolemia
  • Guillain Bare
  • leukostasis
  • Sickle cell
  • Myasthenia gravis
  • hyperviscosity in monoclonal gammopathies
34
Q

Universal donor bloodtype

A

0

35
Q

Universal recipient bloodtype

A

AB

36
Q

1) When does Rh status matter? 2) Management

A

1) Women during second pregnancy
2) IVIG

37
Q

What can group A plasma be transfused into?

A
  • Blood groups A and O (has anti-B antibodies)
    *Just think of plasma as opposite of blood
38
Q

What blood cell types can receive Group O plasma?

A

Only Group O because it has pre-existing anti A and B antibodies

39
Q

What is the universal plasma donor?

A

AB (it has no pre-existing anti A or B antibodies)
*Just the opposite as blood

40
Q

Who can accept D+ or D- RBCs?

A

D- can not accept D+
D- can be transfused to D+ or D-

41
Q

What is universal donor in terms of RH status

A

D-

42
Q

Universal plasma donor in terms of RH status?

A

D+

43
Q

Which maternal blood type has greatest risk of causing hemolytic disease in the newborn in pregnant women with father being A+?

A

O+ (IgG directed against A antigen can cause placenta in second pregnancy)

44
Q

WHy can HSCT patients be HLA matched but ABO incompatible?

A

ABO antigens are not expressed on pluripotent stem cells

45
Q

Consequences of major ABO incompatibility with transplant

A
  • acute hemolysis
  • delayed RBC engraftment
46
Q

What is major ABO incompatibility in transplant?

A

Recipient has pre-formed antibodies

47
Q

What is minor ABO incompatibility in transplant?

A

Donor has preformed antibodies

48
Q

Consequence of minor ABO incompatibility in transplant

A

passenger lymphocyte syndrome

49
Q

Are platelets cross matched?

A

No, express ABO to variable degrees so ABO matching is not necessary for platelet transfusion (HLA system is more relevant than ABO)

50
Q

What does 4 factor PCC include?

A

4 factors - II, VII, IX, X (this is why it is given for warfarin-associated bleeding)

51
Q

Management of subsequent transfusion in patient with significant urticaria and pruritus

A

Transfuse washed RBCs

52
Q

Acute hemolytic reaction pathophys

A

Pre-existing antibodies in recipient reacting against antigens in transfusion

53
Q

Acute hemolytic transfusion reaction clinical features

A
  • pain
  • fever
  • dark urine
  • intravascular hemolysis
  • DIC
54
Q

DAT result with an acute hemolytic reaction

A

IgG + complement (complement fixation leads to hemolysis)

55
Q

Febrile nonhemolytic reaction pathophys

A

Antibodies to leukocytes in blood product leading to cytokine production

56
Q

TRALI pathophys

A

Anti-HLA or antineutrophil antibodies

57
Q

How do blood banks reduce TRALI incidence?

A

Exclude high risk donors (women with multiple pregnancies)

58
Q

delayed hemolytic reaction pathophys

A

Recipient has antibodies that are below the detectable limit at time of transfusion. Anamnestic response occurs at time of transfusion (leading to delayed hemolysis)

59
Q

Most commonly implicated antigens with delayed hemolytic transfusion reactions

A
  • Rh
  • Kidd
  • Duffy
  • kell
  • MNSs
60
Q

Transfusion-associated GVHD clinical features

A
  • Rash
  • Jaundice
  • Abdominal pain
  • nausea/vomiting/diarrhea
  • LFT elevation
  • pancytopenia
61
Q

Other indication for red cell exchange

A

Hemolytic disease of fetus and newborn

Heme boards (59 decks)

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